Are You Sure It’s ADHD?

By Alan Wachtel, MD with Eve Kessler, Esq.

If your child has problems with attention, you should notautomatically assume that he or she has ADHD. An array of mental health and medical conditions, learning disabilities, and environmental factors can lead to attention and self-regulation challenges and must be ruled out before establishing an ADHD diagnosis.

Depression, for example, often causes difficulty with focus, motivation, and memory. Anxiety can trigger restlessness, impulsivity, and an inability to “sit still and concentrate.” Behavioral disorders, such as Oppositional Defiant Disorder (ODD) are associated with poor impulse control. Bipolar disorder, Obsessive Compulsive Disorder (OCD), autism spectrum disorder, and tic disorders can also cause behaviors that look like ADHD, such as hyperactivity, impulsive decision-making, risk-taking, hyper-focus, poor concentration, or an inability to shift attention and get started.

Likewise, certain medical conditions, like seizure disorders, iron deficient anemia, chronic ear infections, and hearing and vision impairments may cause symptoms that mimic ADHD. Sleep disturbances resulting in insufficient sleep, whether from poor sleep habits or a sleep disorder, can profoundly impact your child’s ability to focus, be available for learning, and perform well in school, sports, and after-school activities.

Children with reading, written language, and math learning disabilities frequently struggle with issues of inattention, because of their difficulties processing speech and language or auditory and visual information, and their problems with organization, planning, and working memory. So, too, academically gifted children, bored with the lack of challenge in a classroom, may present as inattentive, impatient, and restless.

Situational factors can easily produce tremendous stress for your child and cause behaviors that may be mistaken for ADHD. Having a chaotic or violent home life or family financial concerns; confronting parental conflict or divorce; suffering from neglect or abuse at home; or being the victim of bullying at school or in the community may all impact your child’s emotional and mental health and lead to inattention, distraction, hyperactivity, restlessness, or acting-out behaviors. Similarly, sudden life changes, such as moving to a new home; changing schools; experiencing the death of a close family member or friend; or the birth of a sibling, may affect your child’s mental alertness, focus, and self-control.

The point is that many conditions can lead to problems with attention. It’s therefore critical to get an accurate diagnosis before embarking on a treatment plan. In order to address a problem effectively, you must know what the problem is.

This post is based on the presentation, ADHD Myths & Realities by Alan Wachtel, MD, sponsored by Smart Kids with Learning Disabilities. Dr. Wachtel is a psychiatrist and noted expert in the treatment of ADHD. He is the author of The Attention Deficit Answer Book: The Best Medications and Parenting Strategies for Your Child. Eve Kessler, Esq., an attorney with The Legal Aid Society, NYC, is President of SPED*NET Wilton, CT and a Contributing Editor of Smart Kids.

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